COVID-19 SPECIAL: DocTalk

Helping older folk stay connected

Ensuring older people have smart devices and access to the Internet as well as the ability to use them can alleviate the loneliness felt from social distancing

Collectively, we will have to make sure older people have safe access to Internet-based communication tools and are able to navigate such tools. This is a concrete way to ensure their physical separation does not lead to undesirable psychosocial outcomes.

The advice in many countries is for those aged above 60 to remain at home because they have a higher risk of severe Covid-19 disease.

On March 24, Singapore issued an advisory for older people to avoid social gatherings and crowded places as far as possible and to go out only for essential purposes such as to buy food.

Then, on March 31, Singapore urged extra precautions to be taken while interacting with older family members. For instance, unwell individuals should avoid visiting older family members.

Additionally, consequent to local evidence of the transmission of Covid-19 during social activities and gatherings among older people, all older person-centric activities conducted by government agencies are suspended till April 30.

It is important to note that while broad physical or safe-distancing advisories apply to all individuals, many are targeted at older people.

A likely consequence of the Covid-19 control measures will be the voluntary or involuntary physical separation of older people.

The former is when older people do so themselves and/or at the advice of their family members, subsequent to advisories, while involuntary separation is done consequent to formal government orders.

Given what is known about the epidemiology and transmission dynamics of Covid-19, the physical separation of older people may be a sound public health strategy.

However, it is important to consider the psychosocial impact of such a strategy on older people and take pre-emptive steps to mitigate it.

Already, older people are more likely to have a lower extent of connections with family members outside the household or with friends, and to feel lonelier.


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Data from a national survey of 4,549 older Singaporeans, conducted by the Centre for Ageing Research and Education (Care) at the Duke-NUS Medical School, Singapore, in 2016 to 2017, clearly shows a sharp fall in social network and an increase in loneliness with age.

The proportion of those who have a weak social network increased from nearly 30 per cent in those aged 60 to 69 years to about 45 per cent in the group aged more than 80 years. The proportion of those who are lonely rose from 32 per cent to about 40 per cent for these age groups.

Physical separation would further reduce their social network and increase their loneliness. Those aged above 70 years, who are even more likely to be socially isolated, are worse off.

Weak social connections and loneliness are linked to a multitude of bad health outcomes, including cognitive decline, anxiety, heart disease and mortality, among older people.

From research done by Care, we know that older Singaporeans with a lower extent of social network are more likely to be depressed, and loneliness increases the risk of mortality among them.

These are not light consequences. Yet, we tend to ignore them as they may not always be immediate and obvious. People must be mindful of not only the immediate, but also the long-term well-being of older people.

Making use of technology, be it landline or mobile phones and/or Internet-based communication tools, such as messaging apps, conferencing platforms or online social networks, is the key way forward.

In that same national survey conducted by Care mentioned earlier, we found that 58 per cent of older Singaporeans reported that they did not use the Internet at all.

And 8 per cent reported that they did use the Internet, but faced difficulty in doing so due to their health condition. Again, these numbers were greater for those of higher age.

Older people may need help with procuring devices and learning how to use them and to navigate the Internet.

Communication apps or platforms may be new to them and thus they may need to be guided to use these in a safe and effective manner.

Family members can ensure older family members have access to Internet-enabled devices and are familiar with the common device features and settings. They should reach out and stay in touch with older family members.

Of course, this should be done while observing device hygiene, personal hygiene and safe-distancing precautions recommended in the context of Covid-19.

Community organisations can provide medium-to long-term rental of Internet-enabled devices.

They can also provide online links to simple, bite-sized Internet or communication-app or platform user guides in the four official languages of Singapore as well as commonly spoken dialects.

Equipping older people with safe Internet use will have collateral benefits, such as ability to perform routine banking or financial transactions online and to maintain continuity of care for their chronic health conditions through video consultations.

Collectively, we will have to make sure older people have safe access to Internet-based communication tools and are able to navigate such tools.

This is a concrete way to ensure their physical separation does not lead to undesirable psychosocial outcomes.

• Dr Rahul Malhotra is head of research at the Centre for Ageing Research and Education as well as assistant professor for health services and systems research at the Duke-NUS Medical School, Singapore

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A version of this article appeared in the print edition of The Straits Times on April 06, 2020, with the headline 'Helping older folk stay connected'. Subscribe